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The management of survivors of rape in the Lebanese healthcare setting remains ambiguous. National initiatives have been established to train first-line responders to provide adequate care for these survivors; however, management often remains suboptimal. This article explores current practices and challenges faced in the management of survivors of rape and proposes recommendations for the advancement of care in this setting.

Since the early 1990s, international recommendations have promoted folic acid supplementation during the periconception period as an effective way of preventing neural tube defects (NTDs). However, the adoption of this recommendation remains insufficient. To assess the awareness and actual intake of folic acid among married Lebanese women aged 18-45 years, a cross-sectional study was conducted among 600 women selected from all five administrative districts in Lebanon, using a multistage cluster sampling procedure. An anonymous questionnaire was completed which covered measures of knowledge and use of folate supplements, as well as demographic, socioeconomic and obstetrical factors. Sixty percent of surveyed women (60%; n = 360) had heard about folic acid. Doctors were the most frequent source of information (61.1%) but only 24.7% of women have been told of the correct period during which folic acid supplementation was useful. Overall, only 6.2% had taken folic acid tablets during the adequate period. Younger age, higher education level and stability/sufficiency of income appeared to be significant predictors of awareness among Lebanese women. Actual folic acid intake was significantly associated with younger age, higher number of pregnancies, planning the last pregnancy and having had that last one after 1990. In Lebanon, the level of folic acid awareness and adequate intake remain relatively low. Several approaches should be used to promote folic acid intake including awareness campaigns, and routine counseling by primary health care physicians on folic acid during preconception visits. Keywords Folic acid * Pre-natal * Preconception/ periconception * Pregnancy * Awareness * Prevention * Neural tube defects * Congenital malformations * Middle-East, Introduction Neural tube defects (NTDs) are among the most frequent congenital malformations, affecting about 250,000 pregnancies worldwide. Isolated NTDs occur in approximately 1-1.5 per 1,000 live births [1, 2]. The [...]

Following its climax in the 8th century under the Abbasids of Baghdad, the Arab world entered a prolonged period of division and decadence. 'Western' medicine was introduced in the 19th century with the support of the general population. The historical participation of Arabs in the elaboration of that 'Western' biomedical model and its apparently consensual re-introduction into the Arab world diffused any sense of cognitive alienation vis-a-vis practices promoted initially by non-Arab doctors. In the late 1960s, Islamist thinkers started proposing 'Islamic medicine' as an alternative to the encroachment of the 'Western' biomedical model within Arab and Muslim nations. In Islamic medicine, disease is attributed to lack of attention to the spiritual dimension of human beings, yet intermediate causal pathways are not provided. Alongside 'orthodox' concepts, Islamic medicine promotes some herbal remedies, in addition to faith-healing through prayer and the recitation of holy verses. While most of those practices may be beneficial, they may cause some harm to patients if they entail delaying or denying timely recourse to 'orthodox' medical care. There are currently no Islamic medicine training programs in any Arab country, and Islamic medicine has not emerged as a comprehensive health alternative comparable to other non-Western health models. Keywords: Alternative medicine; Coran; Islamic medicine

Objectives: This cross-sectional survey was conducted to evaluate the awareness and actual professional experience of pediatricians in Kuwait regarding child maltreatment, a topic rarely explored in this part of the world. Methods: Data were obtained from all pediatricians in public hospitals with pediatric emergency services using a structured detailed self-completed questionnaire. Results:The experience of child neglect was more common than that of child abuse in the clinical practice of surveyed pediatricians. Fifty percent of 117 pediatricians (69% of all eligible) reported having encountered at least 1 case of abuse and up to 3 cases of neglect in the past year. Women and younger doctors more commonly recognized hypothetical situations as maltreatment, and believed child abuse and neglect as being common or very common in Kuwait. Other demographic or professional variables did not affect recognition of maltreatment. Participants would most likely alert social workers about suspected maltreatment cases. More than 80% did not know whether there is a legal obligation to report or which legal authorities should receive reports of suspected cases. Discussion and conclusions: National ethical guidelines regarding reporting suspected cases of maltreatment must be established. Laws protecting maltreated children and reporting physicians must be immediately enacted. Additional training is required to help pediatricians, especially expatriates from other cultures, to diagnose with certainty cases of child maltreatment in their practice in Kuwait. Keywords: Abuse; Neglect; Arab; Middle-East

Truthful disclosure of cancer diagnosis is still uncommon in some cultures. In Lebanon, legislation is permissive of non-disclosure. Physicians choose the recourse most agreeable to them. This study's goal was to determine the proportion of Lebanese physicians who choose truthful diagnosis disclosure to cancer patients and to identify factors affecting their choice. A survey of a random sample of Lebanese physicians was conducted to determine the proportion of those who prefer truthful diagnosis disclosure to cancer patients and to identify factors affecting that choice. The survey involved 268 participants representing 10% of all physicians practicing in specialties with potential contact with cancer cases in the Greater Beirut area. It was completed by 212 (79%), of whom 47% would usually tell the patient about cancer. Disclosure preference was not associated with gender, location of medical training, rate of patient contact or teaching activities. It was associated with longer clinical practice and with specialties outside primary care. Most participants were open to changing their policies and considered the patient's desire to know, compliance with treatment and the patient's profession as a physician as most influencing in their choice of disclosure. Exploring the Lebanese public predicament regarding disclosure seems necessary. Key words - patient-doctor communication, Lebanon, cancer disclosure

Abstract Background A significant number of Lebanese medical graduates have emigrated from Lebanon. The objective of this study was to evaluate the hypothesis that the repatriation of Lebanese physicians educated abroad has contributed to the international emigration of recent Lebanese medical graduates. Methods We analyzed the demographic and educational characteristics and the year of registration of physicians registered with the two physician associations in Lebanon as of 2007. We then analyzed the number of new and total registrants and the physician density for the years 1977–2006. Finally we calculated the percentage of Lebanese graduates of the years 1977–2006 registered as of 2007. Results As of 2007, 10,918 physicians were registered in Lebanon. Most were male (80.4%) and graduated from either Lebanese (36.4%) or Eastern European (30.6%) medical schools. The top three regions of specialty training were Western Europe (31.8%), Eastern Europe (28.4%) and Lebanon (25.7%). About half the physicians registered with the Lebanese Order of Physicians as of 2007 joined during the 1990s decade; only 26.2% of these graduated from Lebanese medical schools during that decade. The number of new registrants increased dramatically in the early 1990s and started decreasing in the early 2000s. About 60% of Lebanese medical graduates of the years 1977–2006 were registered in Lebanon as of 2007. Categorizing Lebanese medical graduates by their year of graduation, the percentage registered in Lebanon as of 2007 showed a "dip" for those who graduated in the early 1990s. Conclusion The high number of physicians educated abroad returning to Lebanon after the end of the civil war may have driven recent Lebanese medical graduates to emigrate.

Purpose: This study aims to evaluate trends in the increasing costs of oncology drugs procured by the Lebanese Ministry of Public Health (MOPH) between 2014 and 2016 and to assess the impact of the introduction in mid-2015 of new immunotherapy drugs for the treatment of lung cancer on the overall and specific costs of that treatment. Methods: A secondary analysis of data from the MOPH Cancer Drug Scientific Committee data base was conducted using a total of 18,133 cancer files between 2014 and 2016. Results: Over the 3-year period, about $140 million (USD) was spent on cancer drugs by the MOPH free cancer drug dispensing program. The expenditures increased by 27% after immunotherapy was phased in. The average cost of drugs per patient per year measured across all cancer types increased from $7,000 in 2014 to $8,400 in 2016. Trastuzumab, approved for treating human epidermal growth factor receptor 2–positive breast cancer ranked first in total expenditures for 2014-2015. By 2016, two new immunotherapy drugs had topped the list: pembrolizumab ranked first and nivolumab ranked third, representing 64% of the total cost of lung cancer treatment and approximately 19% of the total yearly budget; beneficiaries represented only 3% of all patients. Conclusion: This update documents the increasing financial impact of newer cancer drugs on the procurement process in the middle-income country of Lebanon. The trend is aligned with the financial burden of cancer drugs worldwide, which calls for a collaborative global response to this crisis. [ABSTRACT FROM AUTHOR]

Background: The implications of rapid aging of the Lebanese population are under-researched. No national studies have so far investigated the living conditions and the health status of urban Lebanese elderly across gender. Methods: This was a cross-sectional study involving 905 randomly selected community dwelling elderly aged ≥65 years living in Greater Beirut. Gender differences were assessed among participants who completed a standardized questionnaire on socio-demographic factors, nutritional, health, and functional characteristics. Results: The sample included 533 men (59%) and 372 women (41%). Elderly were regrouped into 'younger elderly' (≤70 years), and 'older elderly' (>70 years) which represented respectively 44.3% and 55.7% of the total population. Women, regardless of their age, were less educated and more likely to live alone. Moreover, poor nutritional status, self-perceived health, absence of physical activity, comorbidity, polymedication and depression were significantly higher among women. 'Older elderly' women became significantly more functionally disabled compared with men of their age. Conclusions: This study evidenced that Lebanese elderly women were disadvantaged regarding their socio-economic, health and functional status. It is requested a nationwide effort to improve the socio-economic status and the health of Lebanese elderly, especially women. [ABSTRACT FROM AUTHOR]